Currently, many urologists continue to use internal urethrotomy as the standard management for urethral strictures. Most of them do so because their postoperative care is simple, there is a short convalescence period, and the surgical time is<1h, the duration of the catheter is short.
It can be performed on an outpatient basis, it has high success in the immediate postoperative period and, in some cases, it has reasonable economic remuneration, and other clinical characteristics are not considered, both of the patient and of the stenosis which is essential in postoperative surgical success, such as length and location, etiology, number of endoscopic procedures performed, and intraurethral injection of substances.
Therefore, it is essential to consider all the variables to guarantee success for the patient since internal urethrotomy has a variable and wide recurrence rate of criticisms, ranging from 68% to 84%. Therefore, it can be concluded that the ideal patient with urethral stricture for management by internal urethrotomy is one whose stricture is bulbar in location and without spongiofibrosis.
What Is Internal Urethrotomy?
Internal urethrotomy is currently used as the standard treatment for urethral stricture by many urologists. This is mainly because it provides a simple means for postoperative care, a short period of recovery, operating times of less than one hour, the urethral catheter is in place for a shorter period, and the patient can go home the same day.
It also has a high success rate in the immediate postoperative period, and in some cases, it is very cost-effective. However, other clinical characteristics of both patient and stricture critical in postoperative surgical success are not taken into accounts, such as length, location, etiology, repeated endoscopic treatments, and injections of intraurethral substances.
It is, therefore, essential to consider all variables to ensure patient success, as internal urethrotomy has a vast rate of recurrence of stenosis ranging from 68% to 84%. Therefore, we conclude that patients with stenosis are ideal to be managed by internal urethrotomy, particularly those with urethral stenosis in the bulbar region, with different types of trauma, a length less than 2cm, and without spongiofibrosis.
Much is known about internal urethrotomy (UI), and much has been written about its multiple utilities and benefits; however, the ideal patient for this procedure is not yet clearly defined, as it is common to find patients undergoing multiple UIs who persist with urethral stricture, which forces us to think that internal urethrotomy is not a procedure that should be offered to all patients with urethral stricture. , conversely, there is little benefit from this procedure for a specific group of patients.
Multiple treatments have been performed for urethral stricture for many years, from casting with wax and caustics to performing external urethrotomy and handling in the chair of narrowness in 1861 1, which generated a high degree of suffering and torture for patients, with terrible results. Today many urologists for urethrotome use endoscopic internal urethrotomy as first-line treatment for patients with urethral stricture without considering other characteristics of the constriction, with a low probability of success and generating as much morbidity and suffering in them as in ancient times.